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Creekside Terrace Rehabilitation

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About Creekside Terrace Rehabilitation

General Information

Legal Business NameCrestview Manor Nursing And Rehabilitation Center LLC
Ownership TypeFor Profit - Corporation
Changed Ownership In The Last 12 MonthsNo
First Accepted MedicareOctober 25, 1984 (32 years)
Capacity126
Residents83
Percent Occupied66%
Program ParticipationMedicare And Medicaid
Resident And Family CouncilsResident
In HospitalNo
Continuing Care Retirement CommunityNo
Special Focus FacilityNo
Auto Sprinkler System In Required AreasYes

Ratings for Creekside Terrace Rehabilitation

Creekside Terrace Rehabilitation
was reviewed by Medicare to have a rating of 2 out of 5. About Medicare Ratings
Overall Rating
Health Inspections Rating
Quality Measures Rating
Staff Rating
RN Staff Rating

Overall Ratings of Texas Nursing Homes

Fines, Complaints, and Inspection Problems in the Past 3 Years

Compare The Number of Problems

Types of Problems at Nursing Homes

Some issues within a nursing home are much more severe than others. Medicare evaluates each problem based on 2 scales: the number of residents affected by a problem and the severity of the potential or actual harm to residents based on the problem. We have color coded the matrix below to make it easier to pick out the more severe problems. In general, orange and red issues related to the treatment of a resident are considered substandard quality of care.

  Residents Affected
Severity of the Deficiency Few Some Many
Immediate jeopardy to resident health or safety J K L
Actual harm that is not immediate jeopardy G H I
No actual harm with potential for more than minimal harm that is not immediate jeopardy D E F
No actual harm with potential for minimal harm A B C

June 2, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
KSomeImmediate JeopardyHealth InspectionGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
KSomeImmediate JeopardyHealth InspectionMake sure that the facility is administered in an acceptable way that maintains the well-being of each resident .
KSomeImmediate JeopardyHealth InspectionImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
KSomeImmediate JeopardyHealth InspectionEnsure services provided by the nursing facility meet professional standards of quality.
FManyPotential for HarmComplaint+InspectionConduct initial and periodic assessments of each resident's functional capacity.
FManyPotential for HarmHealth InspectionDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
ESomePotential for HarmHealth InspectionMake sure that nurse aides show they have the skills and techniques to be able to care for residents' needs.
ESomePotential for HarmComplaint+InspectionHave a program that investigates, controls and keeps infection from spreading.
ESomePotential for HarmHealth InspectionProvide or obtain laboratory services only when ordered by the attending physician.
ESomePotential for HarmHealth InspectionGive proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.
ESomePotential for HarmHealth InspectionProvide proper discharge planning and communication, of the resident's health status and summary of the resident's nursing home stay.
ESomePotential for HarmHealth InspectionCoordinate assessments with the pre-admission screening and resident review program for mentally-ill and mentally-retarded patients.
ESomePotential for HarmHealth InspectionEnsure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions.
ESomePotential for HarmHealth InspectionProvide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality.
ESomePotential for HarmHealth InspectionGive specialized rehabilitative services that are medically necessary by qualified personnel, when ordered by a doctor.

May 28, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmFire Safety InspectionAn approved automatic sprinkler system connected to the fire alarm system.
FManyPotential for HarmFire Safety InspectionSmoke barrier doors that can resist smoke for at least 20 minutes.
ESomePotential for HarmFire Safety InspectionExits that are accessible at all times.
CManyPotential for Minimal HarmFire Safety InspectionProper backup exit lighting.
CManyPotential for Minimal HarmFire Safety InspectionProperly located and lighted "Exit" signs.

May 6, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
---Payment DenialPayment denial for 15 days
---Fine$57,752 fine

January 2, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$5,525 fine
KSomeImmediate JeopardyComplaintEnsure that residents are safe from serious medication errors.
KSomeImmediate JeopardyComplaintProvide care by qualified persons according to each resident's written plan of care.
KSomeImmediate JeopardyComplaintProvide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse.
ESomePotential for HarmComplaintKeep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.

May 30, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmFire Safety InspectionExits that are accessible at all times.
ESomePotential for HarmFire Safety InspectionAutomatic sprinkler systems that have been maintained in working order.
CManyPotential for Minimal HarmFire Safety InspectionHeating and ventilation systems that have been properly installed according to the manufacturer's instructions.

May 29, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmHealth InspectionHave a detailed, written plan for disasters and emergencies, such as fire, severe weather, and missing residents.
FManyPotential for HarmHealth InspectionDispose of garbage and refuse properly.
ESomePotential for HarmHealth InspectionHave a program that investigates, controls and keeps infection from spreading.
CManyPotential for Minimal HarmHealth InspectionDevelop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property.

November 13, 2013 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$1,300 fine

Staffing Levels Per Resident per Day

Medicare determines the expected staffing time per resident per day depending on level of care the residents of Creekside Terrace Rehabilitation require. It is important to compare the reported time to expected time for a single facility instead of comparing the amount of time per resident of two facilities. Learn why.

2hr 45min
2hr 30min
ReportedExpected
CNA
60min
40min
ReportedExpected
LPN
35min
1hr 10min
ReportedExpected
RN
4hr 15min
4hr 15min
ReportedExpected
Total Nursing

This facility also provides approximately 1hr 50min per resident per WEEK of physical therapist time.

Quality Measures for Long Stay Residents

28.6%
28.8%
28.8%
90.7%
Q1 2015Q2 2015Q3 2015TX
Assessed and Appropriately Given the Seasonal Influenza Vaccine
20.4%
12.7%
13.6%
87.9%
Q1 2015Q2 2015Q3 2015TX
Assessed and Appropriately Given the Pneumococcal Vaccine
-
-
-
46.9%
Q1 2015Q2 2015Q3 2015TX
* The data for this facility for some quarters is unavailable.
Low Risk Residents Who Lose Control of Their Bowel or Bladder
11.4%
15.8%
18.0%
22.3%
Q1 2015Q2 2015Q3 2015TX
Received an Antipsychotic Medication
17.1%
7.5%
17.9%
19.6%
Q1 2015Q2 2015Q3 2015TX
Need for Help with ADLs has Increased
1.9%
4.5%
0.0%
8.8%
Q1 2015Q2 2015Q3 2015TX
Self Report Moderate to Severe Pain
8.3%
3.3%
0.0%
6.3%
Q1 2015Q2 2015Q3 2015TX
Lose Too Much Weight
7.3%
6.5%
4.5%
6.6%
Q1 2015Q2 2015Q3 2015TX
High Risk Residents With Pressure Ulcers
13.3%
8.9%
14.5%
6.1%
Q1 2015Q2 2015Q3 2015TX
Have Depressive Symptoms
12.2%
11.3%
12.5%
5.1%
Q1 2015Q2 2015Q3 2015TX
With a Urinary Tract Infection
2.0%
0.0%
0.0%
3.5%
Q1 2015Q2 2015Q3 2015TX
Experiencing One or More Falls with Major Injury
5.3%
4.1%
3.1%
3.3%
Q1 2015Q2 2015Q3 2015TX
With a Catheter Inserted and Left in Their Bladder
0.0%
0.0%
0.0%
0.6%
Q1 2015Q2 2015Q3 2015TX
Were Physically Restrained

Quality Measures for Short Stay Residents

9.7%
9.3%
8.0%
71.4%
Q1 2015Q2 2015Q3 2015TX
Assessed and Appropriately Given the Pneumococcal Vaccine
11.1%
11.1%
11.3%
71.1%
Q1 2015Q2 2015Q3 2015TX
Were Assessed and Appropriately Given the Seasonal Influenza Vaccine
6.2%
6.1%
8.8%
16.5%
Q1 2015Q2 2015Q3 2015TX
Self Report Moderate to Severe Pain
0.0%
0.0%
3.8%
3.2%
Q1 2015Q2 2015Q3 2015TX
Newly Received an Antipsychotic Medication
0.0%
0.8%
0.8%
1.0%
Q1 2015Q2 2015Q3 2015TX
With Pressure Ulcers That Are New or Worsened